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Psychiatry ` Psychiatry—Pathology Psychiatry ` Psychiatry—Pathology sEctiON iii 563
Panic disorder Recurrent panic attacks involving intense Diagnosis requires attack followed by ≥ 1 month
fear and discomfort +/− a known trigger. of ≥ 1 of the following:
Attacks typically peak in 10 minutes with ≥ 4 Persistent concern of additional attacks
of the following: palpitations, paresthesias, Worrying about consequences of attack
depersonalization or derealization, abdominal Behavioral change related to attacks
pain, nausea, intense fear of dying, intense fear Symptoms are systemic manifestations of fear.
of losing control, lightheadedness, chest pain, Treatment: CBT, SSRIs, and venlafaxine are
chills, choking, sweating, shaking, shortness first line. Benzodiazepines occasionally used in
of breath. Strong genetic component. risk of acute setting.
suicide.
Phobias Severe, persistent (≥ 6 months) fear or anxiety due to presence or anticipation of a specific object or
situation. Person often recognizes fear is excessive. Treatment: CBT with exposure therapy.
Social anxiety disorder—exaggerated fear of embarrassment in social situations (eg, public
speaking, using public restrooms). Treatment: CBT, SSRIs, venlafaxine. For performance type
(eg, anxiety restricted to public speaking), use β-blockers or benzodiazepines as needed.
Agoraphobia—irrational fear/anxiety while facing or anticipating ≥ 2 specific situations (eg, open/
closed spaces, lines, crowds, public transport). If severe, patients may refuse to leave their homes.
Associated with panic disorder. Treatment: CBT, SSRIs.
Generalized anxiety Excessive anxiety and worry about different aspects of daily life (eg, work, school, children) for
disorder most days of ≥ 6 months. Associated with ≥ 3 of the following for adults (≥ 1 for kids): restlessness,
irritability, sleep disturbance, fatigue, muscle tension, difficulty concentrating. Treatment: CBT,
SSRIs, SNRIs are first line. Buspirone, TCAs, benzodiazepines are second line.
Obsessive-compulsive Obsessions (recurring intrusive thoughts, feelings, or sensations) that cause severe distress, relieved
disorders in part by compulsions (performance of repetitive, often time-consuming actions). Ego-dystonic:
behavior inconsistent with one’s beliefs and attitudes (vs obsessive-compulsive personality disorder,
ego-syntonic). Associated with Tourette syndrome. Treatment: CBT and SSRIs; clomipramine
and venlafaxine are second line.
Body dysmorphic disorder—preoccupation with minor or imagined defects in appearance.
Causes significant emotional distress and repetitive appearance-related behaviors (eg, mirror
checking, excessive grooming). Common in eating disorders. Treatment: CBT.
Trichotillomania Compulsively pulling out one’s hair. Causes significant distress and persists despite attempts to stop.
A Presents with areas of thinning hair or baldness on any area of the body, most commonly the scalp
A . Incidence highest in childhood but spans all ages. Treatment: psychotherapy.
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